DEPARTMENT OF HEALTH BUREAU OF HEALTH FACILITIES AND SERVICES

Atty. Nicolas B. Lutero III, CESO III Director IV Regalla Towers, 29 July 2011 Objectives 1. General To acquire a broad-based view of the requirements for licensing of hospitals. 2. Specific To orient stakeholders on the licensing rules and requirements in hospital planning and design; To clarify issues and enlighten stakeholders on the same.

Acronyms 1. BHFS Bureau of Health Facilities and Services 2. CHD Center for Health Development 3. CON Certificate of Need 4. DOH-PTC DOH Permit to Construct 5. OSS One-Stop Shop 6. LTO License to Operate Flow of Presentation 1. Certificate of Need 2. DOH Permit to Construct 3. Guidelines in the Planning and Design of a Hospital 4. Evaluation Procedure 5. One-Stop Shop 6. Re-Centralization

 Definition of a Hospital A place devoted primarily to the maintenance and operation of facilities for diagnosis, treatment and care of individuals suffering from illness, disease, injury or deformity or in need of obstetrical or other medical and nursing care.

Definition of a Hospital The term hospital shall also be construed as any institution, building or place where there are installed beds or cribs or bassinets for 24 hour use or longer by patients in the treatment of diseases, diseased-condition, injuries, deformities or abnormal physical and mental states, maternity cases and sanitarial or sanitarial care infirmities, nurseries, dispensaries and such other means by which they may be designated.

Definition of a Hospital The term clinic means a place in which patients avail of medical consultations or treatments on an out-patient basis. However, any clinic or dispensary where there is at least 6 beds or cribs or bassinets installed for 24 hour use by patients shall be construed to fall within the definition of a hospital as described in this Act.

Certificate of Need (CON) A CON is a certificate issued by the CHD Regulatory Division for proposed construction of a hospital that ensures that the facility will be needed at the time of its completion. The certificate is issued to an individual or group intending to build a hospital to meet the needs of a community. A CON is required prior to securing a DOH-PTC for the construction of a hospital. CON Criteria for the establishment of a new general hospital: 1. Bed to population ratio shall not be more than 1 bed per 1,000 population (1:1,000); 2. Travel time proposed hospital shall be at least 1 hour away from the nearest existing hospital; 3. Accessibility strategically located; CON

Criteria for the establishment of a new general hospital: (cont.) 4. Integration with Provincial/ City Strategic Plan for the Rationalization of the Health Care Delivery System Based on Health Needs; 5. Track record. CON Requirements for general hospitals: Application form for CON Certification from the Provincial Planning and Development Office that the proposed hospital is part of the duly approved Provincial Hospital/ Health Care Delivery Plan (if available) DOH Permit to Construct (PTC) An authorization issued by the DOH in compliance with the standards and technical requirements particularly on zoning/ functional relationship of areas for the construction, substantial alteration, expansion or renovation, change in classification and/ or increase in bed capacity of hospitals and other health facilities. It is a pre-requisite for the issuance of LTO/ certificate of accreditation. Coverage of DOH-PTC Ambulatory Surgical Clinic Dialysis Clinic Drug Testing Laboratories Drug Abuse Treatment and Rehabilitation Center Hospital Medical Facility for Overseas Workers and Seafarers Psychiatric Care Facility Composition of the Health Facility Establishment Review Committee (HFERC) Chairman: Director of the BHFS (CO) Chief, Licensing Regulation and Enforcement Division (CHD) Members: Architect Physician

Engineer Health Physicist Nurse

Medical Technologist Pharmacist

Application for DOH-PTC Classification of Hospitals A. By function 1. General 2. Special B. By service capability 1. Level 1 2. Level 2 3. Level 3 4. Level 4 5. Guidelines in the Planning and Design of a Hospital Planned and designed to observe appropriate architectural practices, to meet prescribed functional programs, and conform to applicable codes as part of normal professional practice References shall be made to the following: PD 1096 National Building Code of the Philippines + IRR PD 1185 Fire Code of the Philippines + IRR PD 856 Code on Sanitation of the Philippines + IRR BP 344 Accessibility Law + IRR RA 1378 National Plumbing Code of the Philippines + IRR RA 184 Philippine Electrical Code RA 4226 Hospital Licensure Act + IRR Existing Local Codes and Ordinances

Manual on Technical Guidelines for Hospitals and Health Facilities Planning and Design. DOH, Manila. 1994 Signage Systems Manual for Hospitals and Offices. DOH, Manila. 1994

Health Facilities Maintenance Manual. DOH, Manila. 1995 Manual on Hospital Waste Management. DOH, Manila. 1997. District Hospitals: Guidelines for Development. WHO Regional Publications, Western Pacific Series. 1992 Guidelines for Construction and Equipment of Hospital and Medical Facilities. American Institute of Architects, Committee on Architecture for Health. 1992

De Chiara, Joseph. Time-Saver Standards for Building Types. Mc Graw Hill Book Company. 1980.

ENVIRONMENT Readily accessible to the community and reasonably free from undue noise, smoke, dust, foul odor, flood and shall not be located adjacent to railroads, freight yards, childrens playgrounds, airports, industrial plants, disposal plants OCCUPANCY Building(s) designed for other purpose(s) shall not be converted into a hospital. Comply with all local zoning ordinances Guidelines in the Planning and Design SAFETY Provide and maintain a safe environment No hazards to life and safety Capable to withstand weight and elements to which they may be subjected to exits shall be restricted to the following types: door building, interior stair, ramp and exterior stair floor of the building outside of the building leading directly outside the

minimum of 2 exits, remote from each other for each exits shall terminate directly at an open space to the Guidelines in the Planning and Design SECURITY

 Ensure security of person and property within the facility LIGHTING Sufficient illumination to enable performance of work and to promote comfort, healing and recovery of patients VENTILATION Adequate ventilation AUDITORY AND VISUAL PRIVACY Observe acceptable level and adequate visual seclusion to achieve the acoustical and privacy requirements in designated areas allowing the unhampered conduct of activities Guidelines in the Planning and Design WATER SUPPLY Approved public water supply system Potable, safe for drinking and adequate and shall be brought into the building free of cross connections. SANITATION Utilities for the maintenance of sanitary system, including approved water supply and sewerage system, shall be provided through the buildings and premises to ensure a clean and healthy environment. Guidelines in the Planning and Design WASTE DISPOSAL Liquid waste shall be discharged into an approved public sewerage system whenever available. Solid waste shall be collected, treated and disposed of in accordance with applicable codes, laws or ordinances. Guidelines in the Planning and Design HOUSEKEEPING Provide and maintain a healthy and aesthetic environment MATERIAL SPECIFICATION

 Floors, walls and ceilings shall be made of sturdy materials that allow durability, ease of cleaning and fire resistance. SEGREGATION Wards shall observe segregation of sexes. Separate toilet for patients and personnel, male and female with a ratio of 1 toilet for every 8 patients and personnel Guidelines in the Planning and Design FIRE PROTECTION Measures for detecting fire such as fire alarms in walls, peepholes in doors or smoke detectors in ceilings Devices for quenching fire such as fire extinguishers or fire hoses that are easily visible and accessible in strategic areas PARKING Minimum of 1 parking space for every 25 beds

Guidelines in the Planning and Design NO SMOKING POLICY There shall be a no smoking policy and that the same shall be strictly enforced. SPACE REQUIREMENTS 0.65/person unit area/ person occupying the space at one time 5.02/staff work area/staff that includes space for 1 desk and 1 for occasional visitor, space for aisle 7.43/bed clear floor area/bed that includes space for 1 bed, space visitor, passage for equipment 1.08/stretcher clear floor area/stretcher that includes space for 1 stretcher 3.72/bassinet clear floor area/bassinet that includes space for 1 space for movement of person, and space for bassinet, for occasional chair, space

passage of equipment

8.36/dental chair clear floor area/dental chair that includes 1 dental chair, space for movement of person, space for passage Evaluation of Floor Plan of equipment

 Compliance to requirements based on the checklist for review of floor plans (Level 1, Level 2, Level 3, Level 4 hospitals) Compliance to space requirements (ancillary service) Proper zoning of areas Functional relationship of areas Flexibility in the proposed nursing units/area Causes of Delay in Processing PTC Insufficient documents submitted Lack of floor plan submitted Scope of work not clearly stated Unlabelled floor plan Unsigned plan submitted Non-payment of PTC fee One-Stop Shop (OSS) A strategy by the DOH to harmonize licensure of hospitals, its ancillary and other facilities, such as but not limited to, the following: Clinical laboratory; HIV testing laboratory; Laboratory for drinking water analysis; Blood bank, blood collection unit, and blood station; Dialysis clinic; Ambulatory surgical clinic; Pharmacy; Medical x-ray facility.

OSS Exclusion OSS excludes the following: Hospital-based medical facility for overseas workers and seafarers; Hospital-based drug abuse treatment and rehabilitation center;

Facility using radioactive material regulated by the PNRI; Performance of kidney transplantation; Drug testing laboratories.

Rationale for Re-Centralization 1) There is a BHFS study mapping out all services and equipment available in hospitals nationwide, particularly Levels 3 and 4 hospitals. 2) There is no approved, rationalized CHD staffing requirement after 2 years of decentralization. 3) The plantilla position at the CHD level revealed inadequate number of technical staff in the Licensing and Enforcement Division. 4) The BHFS is the authorized regulatory body to undertake PTC and LTO applications under Republic Act No. 4226 Hospital Licensure Act of 1965. 5) Transitory Provisions 6) The CHDs, shall submit to the BHFS an inventory report of all pending applications for PTC, initial LTO and renewal of LTO of Levels 3 and 4 hospitals in their areas of jurisdiction since its decentralization last 1 January 2008. 7) All new requests for PTC, issuance of initial LTO of hospitals and renewal of LTO of Levels 3 and 4 hospitals shall be directed to the BHFS after the 8th of January 2011. 8) The foregoing provisions shall be temporary in nature and fulfillment of the conditions under Section I Background a) to d) of AO No. 2010 0035 shall merit the decentralization again of these functions to the CHDs. Draft Policy on Hospital Regulation 1) Streamlining of Licensure and Accreditation of Hospitals DOH licensed hospitals shall automatically be accredited as Centers of Safety by PhilHealth 2) Applications for DOH-PTC of Level 1 and Level 2 government hospitals identified and financed under the Health Facilities Enhancement Program (HFEP) shall be decentralized to the CHD HFERC. ISSUES/ CONCERNS

cyros_2005@yahoo.com.ph cyros88@gmail.com 711-9572, 651-7800 loc 2525 Standards Development Division Bureau of Health Facilities and Services Department of Health Bureau of Health Facilities and Services (BHFS)

DOH Website www.doh.gov.ph Doing Business Licensing BHFS Requirements Hospitals and Other Health Facilities Thank You. DOH website: www.doh.gov.ph Look for Doing Business Click Licensing, Look for Requirements for Licensing Browse the page and click health facility of interest Bureau of Health Facilities and Services Guidelines in the Planning and Design Management plan including, policies, procedures, programs, risk assessment, hazard surveillance that address the following: Safety Security Disposal and control of hazardous materials/ biologic wastes MOA/ contract of outsourced services for waste management

 Emergency and disaster preparedness check for exit plans, plans for earthquakes and other disasters Fire safety check for presence of fire extinguishers Radiation safety Utility systems Water safety water analysis results